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Andreas Killen's book joins a spate of other recent studies on the history of nervousness in late-nineteenth- and early-twentieth-century Germany.[1] Like them, it delves into themes that will be familiar to readers interested in the fraught and ultimately catastrophic path that Germany took to modernity. The subject matter ranges widely across the neurological debates in the 1870s and 1880s, the phenomenon of railway spine and medical discourse about traumatic neurosis, Otto von Bismarck's social insurance legislation, the electrotherapeutic techniques applied to Kriegszitterer during the First World War and nervous telephone operators in the Weimar Republic.

The book's master narrative is easily summarized. In Killen's account, Bismarck's system of social insurance sought to mediate the ruptures that modernization had inflicted upon the German body politic. As a symptom of those ruptures, nervousness was coded as a somatic disorder and as such included in a larger socio-medical consensus about the morbid effects of rapid industrialization and urbanization. Ultimately, however, Bismarck's system and the "insurance community" (p. 212) it engendered proved incapable of managing the psychological crises spawned by modernity. Instead, and not least because of the trauma of the First World War, the "medical validity" (p. 213) of neurasthenia was rejected and responsibility for nervous disorders was passed from society back to the individual. As part of a broad medical "backlash" (p. 3) that recoded nervousness as a psychological rather than a somatic disorder, insurance claims of disabled war veterans and telephone operators were dismissed as mere epiphenomena of the social welfare system. In the most succinct statement of the book's central hypothesis, Killen writes: "Losing its anchorage in the individual body, nervous illness became inscribed in more collectivist notions of heredity and mass psychology, even as medical experts shifted the burden of diagnosis away from the technological discontents of modern life to the pathologies of the bureaucratic social state" (p. 14). In general, this narrative is recounted in the thrall of modernist tropes: Weberian notions of rationalization, the bureaucratization and social disciplining of everyday life and the "exceptional intensity of the German experience of the modernizing process" (p. 37) are pervasive themes throughout the book. Killen draws heavily on the work of Anson Rabinbach, Detlev Peukert, Paul Lerner and Greg Egighian, at times so much so that it is difficult to assess whether or how he advances their arguments.

In constructing this narrative about "shock, nerves and German modernity," Killen is keen to emphasize two points that have not received sufficient attention in the historiographical literature. First, he sees neurasthenia as becoming increasingly psychologized. By his account, the "consolidation of a new consensus within German medical circles" resulted in neurasthenia being "reconfigured as a pseudoillness" (p. 7) with a psychological, rather than a somatic etiology. Killen is right to stress this tendency, primarily because it has been overlooked by historians eager to construct simpler somatic teleologies in the years leading up to 1933. Killen's account is an important reminder of just how complex and multifaceted German debates about nervousness were. Second, from the outset Killen insists that during the quarter century leading up to the First World War, neurasthenia was transformed into a mass phenomenon that extended far beyond the middle classes. It made deep inroads into the working classes and the modern service sector. In this context, he criticizes Joachim Radkau's Das Zeitalter der Nervosität (1998) for not recognizing the extent to which nervousness permeated German society (p. 10). In support of his argument, Killen points convincingly to Haus Schönow, Berlin's most prominent hospital for nervous workers.[2]

This evidence reveals one way in which Killen's study differs from previous monographs: in its focus on Berlin. As the book's title suggests, Killen interprets Berlin as the focal point of the second industrial revolution and as the principle stage on which Germany's drama of modernization was acted out. As the capital of nervous breakdown, Berlin became a laboratory for new technologies of the self and Killen uses the city to examine "how rationalization ... left its imprint on the self--how German consciousness became ... 'industrialized'" (p. 12). Citing the work of Georg Simmel, he emphasizes the "centrality of the constellation of electricity, shock, and nerves in turn-of-the-century discourses on the metropolitan self" (p. 47).

This focus on Berlin is, at once, both a strength and the great weakness of the monograph. The phenomena Killen describes can in no way be bounded by such an amorphous urban entity as the city of Berlin. As a consequence, he is sometimes forced to bend the historical evidence in order to make it point to the Prussian capital. These efforts are often contrived, such as when he stresses that Wilhelm Griesinger was a "Berlin psychiatrist" (p. 16), that Wilhelm Erb was "associated" with Hermann von Helmholtz's Berlin school of physiology (p. 53), or when, conversely, he fails to mention that figures such as Karl Lamprecht and Wilhelm Wundt (pp. 30, 33) hailed from a distinct school of positivist thought located in Leipzig, not Berlin.

The difficulties that arise in trying to make Berlin stand pars pro toto for the larger drama of modernization is symptomatic of a kind of synecdochic style of argument that hampers much of the analysis. Too often sweeping claims are buttressed not by systematic evaluation of the historical evidence, but by recourse to a single patient record or the writings of one psychiatrist. For example, the views of Ewald Stier are taken as those of the entire psychiatric profession; Fritz Kaufmann's electrotherapy is represented as the cure dispensed by all wartime practitioners. Most controversially, the suggestion that the entire psychiatric profession "embraced" (p. 128) Kaufmannization, that the therapy was "widespread" (p. 140) and "increasingly coercive" (p. 149) rests on thin evidence and stands in marked contrast to other, better documented studies. Similarly, the claim that the psychiatric profession was reorganized und centralized under military direction during the First World War (pp. 135, 144) is implausible; on the contrary, basic institutions and structures of the discipline remained little changed by the war.

Finally, it is unfortunate that much recent literature has not been consulted in preparing the book. On Gustav Fechner, Killen cites Boring (1950), but not Lennig (1994), on Rudolf Virchow he cites Ackerknecht (1953/81), but not Goschler (2002), and on Wilhelm Griesinger he cites Leibbrand and Wettley (1961) and Dörner (1969/81), but not Sammet (2000) or Verwey (2004).[3] All of this is not to argue that what older authors had to say was incorrect, but simply that instead of engaging recent scholarship, Killen often takes rather dated accounts as points of departure for his narrative.

This book has the misfortune of being published in the shadow of Hans-Georg Hofer's excellent cultural history of neurasthenia.[4] Whereas Hofer's social-constructivist approach has opened up a wide range of engaging new perspectives on nervousness and neurasthenia, Killen's book seems caught up in an older, increasingly exhausted discourse about Germany's path to modernity.

[2]. Given that one of the core arguments of the book is that neurasthenia became a mass phenomenon, it is surprising that the most authoritative work on this institution was not consulted. See Renate Ulrike Amberger, "Haus Schönow. Von der Heilstätte für Nervenkranke zur Klinik für Akutgeriatrie" (Diss. med., Free University of Berlin, 2001).